Permit CITY OF TIGARD PLUMBING PERMIT
II I I.- COMMUNITY DEVELOPMENT Permit #: PLM2012 -00237
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012
Parcel: 1 S136AC04200
Jurisdiction: Tigard
Site address: 7130 SW PINE ST
Project: Andrews Subdivision: 1991 -002 PARTITION PLAT Lot: 2
Project Description: Sewer line repair, less than 100' feet.
Contractor: ENVIRONMENTAL WORKS Owner: ANDREWS, LINDA
2634 SE STEELE ST 7130 SW PINE ST
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503 - 719 -6715 PHONE:
FAX: 503 -482 -7440
FEES
Quantity Description Date Amount
25 If Sewer Service 08/16/2012 $62.54
Specifics: 1 12% State Surcharge - 08/16/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 08/16/2012 $9.96
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notificat'• • . Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct qu> ions to OUNC b alli • • 503.232.1987 or 1.800.332.2344.
Issued B : / I ,, / / Permittee Signat 410P 4,1 '- raXgri `
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
08/16/2012 07:33 p T0: +1 (503) 5981960 FROM:5034827440 Page: 1
- Fax Transmission
To: 5035981960 From: Mathew Lowrance
Fax: +1 (503) 5981960 Date: 8/16/2012
RE: Pages: 3
Comments:
08/16/2012 07:33 p T0: +1 (503) 5981960 FR0R:5034827440 Page: 3
Plumbing Permit Application No) , Site Utilities RBCE' FOR OFFICE I:SE ONLY
City of Tigard Remi d Bell (Qi12'
I
a 13125 SW I loll Blvd.. Tiganl. OR 97221 ' 6 012 Platt Review
Phone: 5(13.718.2439 Fay: 503.5')8.1960 n(1 Date' Other ermil No.:
Ins Lint' ,nc• 303 619.4173 0� A `` Dare Read By: V ® See Pagel (nr
TIGARD Internet: www.ligurd ur.eov JINN I n/V1 Nutif',ed1Mellmd: Supplemcntallnformation
TYPE OF�Q� � G f, I FEE* SCHEDU LE
Fur s' rein/ in urmuaon use checklist.
❑ New cnnstrueliun ❑ Demolition
f hscriptinn v. Ea _ total --
❑ Add itianralteratittn`rcplacemcm I Other: New l- 2-family dwellings t includes 1(11 ft_ lhreach unlit{ connection)
CATEGORY OF CONSTRUCTION SFR II) bath 312.70 I
Sr k i2) bath 437.78
I- and 2- family dwelling ❑ Commercial/industrial
SFR (3) bath
❑ Accessory building _- - ❑ Multi-family - -- _ -- Each additional bath/kitchen 25.02 I
I ❑ Master builder I Other: sprinkler Page 2 --L--. ❑ Fire s rinkler t . sq. ti.l'
JOB srri: INFORMATION AND LOCATION Site utilities:
, ` \ ,�•�p ._ 4:- L ('arch basin or area drain - I - I Y.76 I
Job s ite address 13 + S W _ )- LIS._ ��T
[� ^ ^^�� Ilnwdl. leach lino or trench drain I8.16
I Cite! \Lola' /II_ t Q( C N...... `l 1 3ccsr� I Porting drain (no. line:u Ile. 1 Paee 2
i Suite/bldg /apt. no.: J Project name: -_ _
4 - l \tanufacturcd home utilities 50.01
( "toss street/directions to job site: -- -- - Manholes 18.76
._. - Ruin drain connector I 18.76
Sanitary sewer (no. linear A;�
.4 1 Page 2
1 __- Storm sewer (no. linear ft.: I Page 2
I Water service (no. linear ft.: _I Page 2
I Subdivision: ^ -- I Lot no.: Fixture or item:
r ---- Backfow preventer 31.27
lax map /parcel no.: I 1
Backwater valve 12.51 1 -
DESCRIPTION OF WORN Clothes washer 25.02 I
��Q. 23.02
'C 1.-
. ->•0� �e�`� _. _ - Dishwasher r , ;Il� � -- ---- --
__.�� 9 sue'( V.1\,.... Drinking fountain - -- ._l
Fjectors/sunip 25.02
Expansion tank 12 51
(PROPERTY OWNER ❑ TENANT - -.. -..
Fixture/sewer cap 25.02
IName: L i r _._ re ws -- - - - 2; 02
Flo drain/floor sink/hub
I Address: - -- 25.02
Garbage disposal t
1 (•itv'Statc/LIP: lime bib i 25 02
Phone ( ) -- - ........_.__ I h as: ( 1 Ice maker I 12.51
I ❑ APPLICANT I X CONTACT PERSON Interceptor /grease trap I 25.0'
I
I Medical gas (value: i i
_ I I Page 2
I Business name: - Primer 12.51 j
Contact name: &A LA 0,.,\(,,c\ Roof drain (commercial) 12.51 - -_
Address: SiSink/basin/lavatory 25.112
('it) iStale / %1P: Solar units (potable water/ -�
62.5
-- - (y� a c i - 3 a) Fax: : f ) Toll/shower/shower pan I 12 Si
1'ho nc:
� Urinal 25.02
E: -mail: �� croR IA \(� -_ - - - -, I 2 25.02 I '
-- - r. `h'2- c�� ��'ater c
_ - - C(3N I'w\(. IY)R 4 Nei - - -- Water heater 37.52 r
` Business name: �,I( \ 1r uY��C`r‘tC C.\ 1 ` I Water piping/0%A' ,(' 29
Address: i Addre I '5.02
-• - - Ca '5f.." _ 2 _._
I Cit./State/71P: O\ c\ Subtotal
1, O
1- - - -- Minimum perm fee: $72.50
1 Phone: ( '\ ‘ ct u 5 i Fax: (G t9)1 `1 ba . MO O r 1
�O�l Plan rec sew (25% or feel �
l (R Lie.: s7 Plumbing tic. no.: State surcharge (12°i of permit feel
Authorised signature: ..6(
\i' - \ \ 1 }X') i FOl A1. PL'RMrr tI• 61, ao I
U w.' Print name: a 7hit permit application etpirm it'll permit is nut obtained xithin MI du),
�� P �1(t .t1 Q \ 1 ,(I� S Date: $ a t i I ✓ after it has been accepted as complete.
\� •Fee methodology set by Trld:owny Building ladus!r Set ce Board
I tn. Iaeee.Perrtu<•PI mt din :omits, .1.04o16T1,A"a 2'C0\6'WEtI